Mitral Annulus and Leaflet Calcification

• Mitral annulus frequently calcifies over the age of 60
• One of the most common cardiac calcifications
• Has been considered to be a degenerative process
• Calcification is actually subvalvular in location
• Associations
• Aortic stenosis
• Hypertrophic cardiomyopathy
• Chronic renal failure, especially of those on dialysis
• Bacterial endocarditis
• Systemic hypertension
• Diabetes mellitus
• Hypercholesterolemia
• It may be associated with significant atherosclerosis
• In one study, it was found to be associated with twice the risk of stroke, independent of other risk factors
• In another study, it was associated with an increased prevalence of coronary artery disease in patients <65
• Calcific deposits can lead to cardiac conduction disturbances
• Usually occurs over the age of 40, more often after 65-70
• More common in women
• Not clinically significant unless massive
• May lead to mitral insufficiency
• Shaped like a U, J or reverse C
• Appears as a band of increased density
• Echocardiography and CT are most sensitive means of imaging it
• Mitral leaflet calcifications
• Formerly calcification of the mitral valve itself was most commonly due to rheumatic fever
• Rheumatic fever produces valve abnormalities leading to stenosis and regurgitation, including:
• Calcification and thickening of leaflets and chordae tendineae
• Fusion of commissures
• Can also occur as a degenerative process
• Prevalence increases with age
• Found in 75% over age 80 on CT
• Not associated with mitral stenosis
• Whereas aortic valve calcifications are invariably associated with aortic stenosis
• When rheumatic in origin, mitral valve calcification is usually associated with mitral stenosis
• Imaging findings
• Heavier calcific deposits in men than women
• Not usually apparent on conventional radiography
• Calcium usually deposited in clumps on valve leaflets
• On a lateral chest radiograph, a line drawn connecting the carina and the anterior costophrenic sulcus will usually mark the location of the aortic valve above and the mitral valve below

Calcification of the Mitral Annulus . The blue arrows point to dense, amorphous calcification
arranged in a curvilinear path that corresponds to the location of the annulus of the mitral valve.

For the same photo without the arrows, click here